Perioperative Antibiotic Prophylaxis for Patients With Anorectal Malformation Carrying Carbapenemase-Producing Enterobacteriaceae

Abstract

We report two cases of patients with anorectal malformations and who carried carbapenemase-producing Enterobacteriaceae (CPE), with the focus on perioperative antibiotic prophylaxis. Case 1: A 16-month-old girl who carried CPE with persistent cloacae underwent anorecto-urethro-vaginoplasty. CPE was isolated during preoperative bacterial screening by a transverse colostomy swab. Gentamicin and cefmetazole were administered for three days, from one day before the operation. Case 2: A three-month-old boy who carried CPE had imperforate anus (rectovesical fistula), congenital urethral stricture, and prune belly syndrome. CPE was isolated from his urine at the age of 23 days and from a transverse colostomy sample at the age of 35 days. As refractory urinary tract infections developed repeatedly since CPE isolation, right nephrectomy was performed. The urinary tract infection that developed after nephrectomy was mainly caused by methicillin-resistant Staphylococcus aureus (MRSA); therefore, laparoscopy-assisted anorectoplasty was performed to separate the urinary tract from the colon at the age of 114 days. Fosfomycin and cefmetazole, in addition to linezolid for MRSA, were administered for five days, starting two days before the operation. In both cases, the patients were discharged without surgical site infection. Perioperative antibiotic prophylaxis for patients with CPE should be determined according to antibiotic sensitivity tests and the anatomical communication between the surgical and colonizing sites.